Healthcare Provider Details

I. General information

NPI: 1205040466
Provider Name (Legal Business Name): KONSTANTINE NICHOLAS TSIONGAS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 MAIN RD
TIVERTON RI
02878-4226
US

IV. Provider business mailing address

1106 MAIN RD
TIVERTON RI
02878-4226
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-1606
  • Fax:
Mailing address:
  • Phone: 401-625-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD05688
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: